The 10 Strategic Points
Broad Topic Area 1. Broad Topic Area/Title of Project:
Improving Postpartum Depression Screening and Education to Childbearing Women in a Primary Care Clinic
Literature Review 2. Literature Review:
a. Background of the Problem/Gap:
The postpartum period is a time where many women feel the most vulnerable because of the varied emotional symptoms (Abdollahi, Lye, & Zarghami, 2016). Postpartum depression (PPD) is an emotional problem typically linked with childbirth (PPD) (Abdollahi et al., 2016). It is one of the mental health conditions that is responsive to treatment if early recognition occurs by the healthcare providers treating the women. Olin et al. (2017) study emphasized the benefits of PPD screening due to the lasting impact it has on mother/baby relationship and other family members.
b. Theoretical Foundations (models and theories to be foundation for the project): The introduction of screening for depression among postpartum women can be informed by the framework of Lewin’s Model of Change. The premise of the model is that the implementation of change in any setting requires unlearning and replacing previous knowledge (Wojciechowski, Murphy, Pearsall, & French, 2016). In the model, the three factors responsible for causing change comprise the driving forces, restraining forces, and attainment of equilibrium (Burnes, 2017). The change occurs in three distinct stages, involving unfreeze, change, and refreeze.
c. Review of Literature with Key Organizing Themes and Sub-themes (Identify at least two themes, with three sub-themes per theme)
A comprehensive literature search will be conducted in indexed databases to identify current studies on PPD and screening. The search will be facilitated by the use of keywords that can be combined to refine the returned studies. Only studies that have been published in English in a peer-reviewed journal in the last five years and can be accessed in the full text will be isolated for use in the review of the literature. The literature review will have two major themes:
Theme 1: Postpartum Depression
Sub-theme 1: Epidemiology of Postpartum Depression
Sub-theme 2: Diagnoses of Postpartum Depression
Sub-theme 3: Treatment methods
Theme 2: Screening for Postpartum Depression
Sub-theme 1: Guidelines for Screening for Postpartum Depression
Sub-theme 2: Types of Screening Programs in Health Facilities
Sub-theme 3: Outcome Measures for showing the Efficacy of Screening Programs
b. Summary
PPD is a chronic mental health problem that affects postpartum women. The condition is diagnosed through screening for the risk of developing depression in pregnant and postpartum women.
• Gap/Problem: Less than half of the target population gets screened for PPD.
• Prior studies: Early detection and initiation of treatment are effective for managing the condition.
• Quantitative application: Outcome measures for analyzing the impact of screening to enable early detection and initiation of treatment will be evaluated.
Significance: The findings will add to the existing body of knowledge about PPD and screening.
Problem Statement 1. Problem Statement:
It is not known if or to what degree the implementation of postpartum depression screening and education would impact the behavioral referral rates when compared with the current clinical practice for women of childbearing years.
Clinical/
PICOT Questions P- Women of childbearing years
I-Postpartum depression screening and education
C-Compared to current clinic practice
O-Decreased PPD and increased behavioral referral rates
T- Four weeks
To what degree does the implementation of postpartum depression screening and education impact the behavioral referral rates when compared to the current clinical practice for women of childbearing years prior to discharge from the primary care clinic in Fontana Ca?
Sample 2. Sample (and Location):
a. Location: California
b. Women of childbearing years
c. Sample: A power analysis performed with power set to .80 and alpha set to .50 projects a suitable sample size of n=56 (28 per group) to detect an effect size of 2.6 with inferential statistics.
d. Inclusion Criteria
Who can participate? Willing nurse employees at a Fontana facility who serve in primary care. Exclusion Criteria
e. Who cannot participate? Nurses in antenatal care who are involved in parallel studies being conducted in the facility.
Define Variables 3. Define Variables and Level of Measurement:
a. Independent Variable (Intervention): The nurse education program on the compulsory screening of pregnant and postpartum women for the risk of developing depression.
b. Dependent Variable: The level of knowledge of care providers comprising the sample and episodes of PPD in the facility where the intervention will be implemented.
1. Define Variables and Level of Measurement:
a. Independent Variable (Intervention): The nurse education program on the compulsory screening of pregnant and postpartum women for the risk of developing depression.
b. Dependent Variable: The level of knowledge of care providers comprising the sample and episodes of PPD in the facility where the intervention will be implemented.
Methodology and Design:
The organization of the project activities will be based on the framework of a pre-test and post-test study design with a quantitative methodology.
Purpose Statement:
The purpose of this quantitative, quasi-experimental, pre-test/posttest quality improvement project is to determine to what degree the implementation of postpartum depression screening and education would impact and increase the referral rates when compared to the current practice for women of childbearing years prior to discharge from a primary care clinic in an urban city.
Data Collection Approach:
Data on the level of knowledge of care providers will be collected by administering a questionnaire for the nurses comprising the sample to fill before and after the implementation of the intervention. Data on the episodes of PPD will be collected by evaluating the health records at two distinct time points to establish counts of the incidences reported in the facility.
Data Analysis Approach:
Collected data will be entered into version 25 of the Statistical Package for Social Sciences (SPSS) for analysis. The analysis will involve descriptive and inferential statistics.
Abdollahi, F., Lye, M., & Zarghami, M. (2016). Perspective of postpartum
depression theories: A narrative literature review. North American Journal of
Medical Sciences, 8(6), 232-236. https://doi.org/10.4103/1947-2714.185027
Burnes, B. (2017). Kurt Lewin: 1890–1947: The practical theorist. The Palgrave Handbook of Organizational Change Thinkers, 1-15. doi:10.1007/978-3-319-49820-1_13-1
Center for Disease Control and Prevention (2020). Depression among women. Retrieved from https://www.cdc.gov/reproductivehealth/depression/index.htm#how
Gerber, M., Holsboer-Trachsler, E., Pühse, U., & Brand, S. (2016). Exercise is medicine for patients with major depressive disorders: but only if the “pill” is taken! Neuropsychiatric Disease and Treatment, 12, 1977. doi: 10.2147/NDT.S110656
Olin, S., McCord, M., Stein, R., Kerker, B., Weiss, D., Hoagwood, K., & Horwitz,
S. (2017). Beyond screening: A stepped care pathway for managing
postpartum depression in pediatric settings. Journal of Women’s Health, 26(9),
966-975. https://doi.org/10.1089/jwh.2016.6089
Stewart, D. E., & Vigod, S. (2016). Postpartum depression. New England Journal of Medicine, 375(22), 2177-2186. doi:10.1056/NEJMcp1607649
US Preventive Task Force (2019). Perinatal depression: Preventive interventions. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/perinatal-depression-preventive-interventions
Wojciechowski, E., Murphy, P., Pearsall, T., & French, E. (2016). A case review:
Integrating Lewin’s theory with lean’s system approach for change. Online.
Journal of Issues in Nursing, 21(2), 4-10.
http://dx.doi.org/10.3912/OJIN.Vol21No02Man04